Endoscopic surgical system with sensing means

ABSTRACT

An endoscopic surgical system which includes an instrument for carrying out a step in the procedure. The instrument is power operated and the system includes sensing elements to control the operation of the instrument.

RELATED PATENT APPLICATION

This is a division of application Ser. No. 08/323,467, filed Oct. 14,1994, pending, which is a continuation of Ser. No. 07/991,619, filedDec. 16, 1992, now U.S. Pat. No. 5,383,880, which is acontinuation-in-part of Ser. No. 07/822,478, filed Jan. 17, 1992, nowabandoned, which is hereby incorporated by reference.

FILED OF THE INVENTION

This invention relates to a system for use in endoscopic procedures.More specifically, this invention relates to a system which willautomatically sense physical properties of the tissue on which theprocedure is being conducted and/or certain parameters of an endoscopicsurgical instrument.

BACKGROUND OF THE INVENTION

Endoscopic surgery has been gaining wide acceptance as an improved andcost effective technique for conducting certain surgical procedures. Inendoscopic surgery, a trocar, which is a pointed piercing device, issent into the body with a cannula placed around the trocar. After thetrocar accomplishes piercing of the abdominal walls, it is removed andthe cannula remains in the body. Through this cannula, endoscopicprocedures are possible. Often multiple openings are produced in thebody with a trocar so that an endoscopic instrument may be placed in onecannula, appropriate viewing mechanisms placed in another cannula andfiber optics for illuminating the surgical field placed in yet anothercannula. Generally, these endoscopic procedures take place underinsufflation. As more is learned about endoscopic procedures and moreinstruments developed, the type of procedures that may be performedendoscopically will increase. Presently, typical procedures are gallbladder removal, tissue repair and various sterilization procedures.

Broadly, the instruments used in surgery can be classified into twobroad classes. One class is manipulation devices; that is, devices whichwill grasp tissue, position tissue, irrigate, apply suction, and thelike. The second class may be termed active devices. Generally, thesedevices either cut or staple tissue and some devices may combine theseactions. Examples of such devices are electrosurgery instruments,ultrasonic instruments, lasers, circular stapling instruments, linearstapling instruments, ligating and cutting instruments and the like.

While endoscopic surgical procedures have substantial benefits to thepatient, they do present certain problems to the surgeon conducting theprocedure. For example, because the active part of the instrument isfurther removed from the manipulative part of the instrument, any slightmovement of that manipulative part is magnified when it reaches theactive part. Hence, when placing and forming a staple in tissue, thehand of the surgeon must be a lot steadier during the endoscopicprocedure than if that same procedure was done during standard opensurgery. Another difficulty arises because the surgeon, conducting theprocedure, cannot see the field in which he is operating in a directmanner but is watching that field on an appropriate video display andmanipulating the instrument based on what he sees on that video display.Hence, in designing endoscopic surgical instruments, considerable effortis made to reduce the force required in order to operate the instrumentand allow the surgeon to have greater control over the instrument. Also,from an engineering standpoint, considerable design engineering isrequired to permit function of the active portion of the instrumentgiven the physical limits of force and stroke of the surgeon's hand.

Another problem, particular to endoscopic procedures, is that thesurgeon can no longer feel tissue with his hands to determine thickness,consistency, texture, etc.

It should also be pointed out, that for medical reasons it is oftendesirable to make endoscopic instruments disposable. A major reason forthis is that small, intricate, reusable instruments are difficult tosterilize and, if you can make the instrument disposable thesesterilization problems are eliminated. However, making the instrumentdisposable will often increase the cost of the instrument and this costmust be balanced with the medical advantage. Another problem withendoscopic instruments is their access limitations; that is, the abilityto manipulate the head of the instrument after it has been placed in thecannula is difficult and the scope of movement is limited.

SUMMARY OF THE INVENTION

The endoscopic surgical system of the present invention provides asystem allowing for a high degree of control in the manipulation of theactive part or business head of an endoscopic instrument. Furthermore,my new system may provide greater access for the head of an endoscopicinstrument during the surgical procedure. My new endoscopic systemallows for greater forces to be applied at the head of the instrumentwhile maintaining that head under stable control during the surgicalprocedure. My new endoscopic system may be disposable and even whendisposable, in certain designs, may provide considerable reduction incost. My new system allows the surgeon to expend less energy during thesurgical procedure thus providing for improved manipulation and controlof the instrument during the procedure. My new endoscopic systemprovides sensing feedback to the surgeon to compensate for the loss oftactile feedback. In certain designs of my new endoscopic system, thesurgeon is provided with considerable knowledge regarding theinstrument. For example, the surgeon may be informed as to the positionof the instrument in the procedure, the operation of the instrument;i.e., whether it is in a position to be activated and activatedcorrectly and the like.

In its broadest sense, my new endoscopic system comprises an instrumentwhich is to be used in conducting a step in an endoscopic procedure.Connected to that instrument is suitable power means which will operatethe active or business head of the instrument to conduct a desired stepin the procedure. The instrument also includes a sensing means whichcontrols and/or monitors the operation of the instrument whileconducting the desired step in the procedure and provides feedbackinformation to the surgeon. According to the present invention, there isprovided an endoscopic instrument which has a head portion for carryingout a step in an endoscopic procedure. The step may be ligating,stapling, cutting, manipulation of the tissue etc. or combinations ofthese steps. Connected to this head portion is a shaft. The instrumentincludes means for applying energy to the head portion either by orthrough the shaft. In preferred embodiments of the present invention,the shaft is encased in a housing and a motion is provided to the shaft;i.e., rotation, longitudinal movement, etc. Means are disposed in thehead of the instrument, to translate the motion of the shaft into asuitable force and/or motion in the head to carry out a desired step inthe procedure; i.e., to set and form staples or to ligate a vessel or tosever tissue and so forth. Also, disposed in the head portion is asensing means which measures the energy, force, or the motion of thehead portion. In some instances, the sensing means may measure one ormore physical parameters of the tissue on which it is to work or of thesurrounding tissue. Inter-connected with that sensing means is a meanswhich controls the energy, force and/or the motion of that head portion.

The present invention will be more readily understood and described inthe attached description of the drawings taken in conjunction with thedescription of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an endoscopic surgical system of thepresent invention interconnected with a microprocessor/controller and avideo display screen;

FIG. 2 is a perspective view of an endoscopic stapling and cuttingsystem in accordance with the present invention;

FIG. 3 is a longitudinal cross-sectional view of the handle portion ofone embodiment of an endoscopic stapling and cutting system of thepresent invention;

FIG. 4 is a detail of the gear reduction assembly.

FIG. 4a is a cross-sectional view taken along line A--A of FIG. 4;

FIG. 4b is a cross-sectional view taken along line B-- B of FIG. 4;

FIG. 5 is a longitudinal cross-sectional view of the shaft of the systemdepicted in FIG. 2;

FIG. 6 is an enlarged longitudinal cross-sectional view of the active orbusiness head of the system depicted in FIG. 2;

FIG. 7 is an enlarged longitudinal cross-sectional view of the head ofthe system depicted in FIG. 6 with the head in a closed position;

FIG. 8 is an enlarged longitudinal cross-sectional view of the head ofthe system depicted in FIG. 6 with the head in the position of firingstaples;

FIG. 9 is an enlarged longitudinal cross-sectional view of the head ofthe system of FIG. 6 with the head in the closed position after firingthe staples;

FIG. 10 is an enlarged longitudinal cross-sectional view of the head ofthe system depicted in FIG. 6 with the head in the open position afterthe staples have been fired;

FIG. 11 is a perspective view of another embodiment of an endoscopicsystem of the present invention useful in placing ligating clips;

FIG. 12 is a longitudinal cross-sectional view of the handle of theinstrument depicted in FIG. 11;

FIG. 13 is an assembly view of the shaft portion of the system depictedin FIG. 11;

FIGS. 14, 15 and 16 are sequential plan view of a clip placed in thehead of the system depicted in FIG. 11 when the clips are open, closingand fully closed, respectively;

FIG. 17 is a longitudinal cross-sectional view of a head of a system ofthe present invention depicting sensing means for sensing properties inthe surrounding environment;

FIG. 18 is a block diagram showing the interrelationship of theprincipal components of one embodiment of a system according to thepresent invention;

FIG. 19 is a block diagram depicting a possible set of hardwarearchitecture for a system of the present invention; and

FIG. 20 comprising FIG. 20A and 28B is a simplified flow diagram of onepossible flow for the control logic for a system according to thepresent invention.

DETAILED DESCRIPTION OF THE INVENTION

Referring to the drawings, there is shown in FIG. 1 a perspective viewof an endoscopic system according to the present invention. In thisFigure an endoscopic stapling and cutting instrument 30 isinterconnected with a controller 31 and a video display monitor 32. Thecontroller includes a microprocessor, power supply, hard-wired logic,sensor interface and motor drive circuits. The instrument is connectedto the controller so that the controller can accept, store, manipulate,and present data. The controller may feed appropriate signals back tothe instrument in order to operate the instrument. The controller alsoacts to supply power to the instrument at the appropriate level,frequency, timing, etc. Within the controller may be several hardwiredlogic circuits controlling critical instrument functions. Also, severalsensing circuits may be incorporated in the controller to measurevoltage, current, power etc. The controller may also include a displayscreen to present the data it has received from the instrument andmanipulate it in a desired way.

In FIG. 2 there is shown a perspective view of the endoscopic instrumentdepicted in FIG. 1. The instrument has a handle portion 40. Extendingfrom this handle portion is a shaft portion 41 and at the end of theshaft portion is a desired head or business portion 42 of theinstrument. The head or business portion is that portion of theinstrument which accomplishes a step in a surgical procedure, whetherthat be ligating, stapling, cutting, manipulating tissue, orcombinations of such steps. The head and shaft portions of theinstrument are constructed so that they can be applied through thecannula of a trocar as is well known in endoscopy.

In the embodiment depicted in FIGS. 2 through 9, the head portion is alinear stapler and cutter; that is, the head portion will place downplural parallel rows of staples with the staples offset in the rows. Theinstrument will also operate a knife to pass between two adjacentparallel rows of staples. Such an instrument staples tissue together andcuts that tissue between the stapled portions. Such instruments are usedin various types of surgical procedures such as bowel and lungresections.

FIG. 3 is an enlarged, longitudinal cross-sectional view of the handleportion of the instrument depicted in FIG. 2. In this embodiment, thehandle portion includes a small DC motor 45 attached to a gear box 46.Extending from the gear box is a rotatable drive shaft. The rotatabledrive shaft extends substantially the length of the handle. Alsoincluded in the handle and interconnected with the DC motor are asuitable on-off switch 48 and a switch 49 to control the power supplybeing provided by the motor. A video display switch may also be providedin the handle if desired. While in this embodiment the motor itself isincluded in the handle, it should be appreciated that the motor could beseparate from the instrument with appropriate connections so that avariety of instruments could be used with detachable motor or powersource. Also, if the instrument is to be interconnected with acontroller to accept, store and manipulate data, the motor may beconnected to such controller and information such as current input,power output, voltage and other parameters may be monitored by thecontroller for manipulation, display, and use in a suitable manner.

As depicted in the cross-sectional views in FIGS. 4, 4a and 4b, themotor shaft 50 extends into the center of the gear box 46. The gear boxcomprises two sets of gears 51 and 52, which reduce the rotation of theshaft 47 with respect to the motor at a ratio of 36:1 or other reductionas desired.

Referring to FIG. 5, there is shown an enlarged, longitudinalcross-sectional view of the shaft portion of the instrument shown inFIG. 2. In this embodiment, the shaft housing 60 is flexible. Throughthe center of the housing there extends the rotating, axially flexible,torsionally stiff shaft 61. The housing connects the handle of theinstrument to the head of the instrument and the flexible shaft isconnected to the drive shaft 47.

FIGS. 6 through 10 are enlarged, longitudinal cross-sectional views ofthe head portion of the instrument depicted in FIG. 2. The views depictthe head of the instrument in the open position prior to being placed ontissue (FIG. 6), in the closed position ready for firing (FIG. 7),during the firing action (FIG. 8), after the firing action has beencompleted (FIG. 9) and in the final open position (FIG. 10) when theinstrument may be removed. In these figures, like parts are identifiedwith the same numerals. The housing 70 of the head is suitably connectedto the shaft housing 60 either by a press fit or ultrasonic welding orother similar means. Extending substantially the length of the head andconnected to the rotating shaft 61 is a threaded rod 71. The threadedrod has a larger diameter portion 72 adjacent the shaft 61 and a smallerdiameter portion 73 for the remainder of the threaded rod. The headincludes a staple or staple cartridge portion 74 and an anvil portion75. The staple portion and the anvil portion are pivotally connected toeach other by the anvil pivot pin 76. Mounted on the larger diameterportion of the threaded rod is a closure nut and extending from thatclosure nut 77 is a closure pin 78 which moves in a slot 79 disposed inthe pivotally mounted anvil portion of the head. When the flexible shaftis rotated, the threaded rod is also rotated and on rotating the closurenut will move down the threaded rod and move the closure pin in theclosure slot to close the anvil portion against the staple portion ofthe head of the instrument. Tissue to be treated or manipulated isplaced between the anvil portion and the staple portion of the head ofthe instrument when in the open position. Power is applied to theflexible shaft to rotate the shaft and the threaded rod and close theanvil portion. As can be appreciated, the amount of torque required topivot the anvil portion about the pivot pin can be sensed and thethickness of tissue between the anvil and the staple portion determined.It is a simple matter for a controller to manipulate this informationand inform the surgeon as to whether or not he has the appropriateamount of tissue between the anvil portion and the staple portion of thehead of the instrument upon closure or whether he has too much or toolittle tissue and should re-manipulate the instrument. For a constantvoltage drive, the force required to close the instrument may bemeasured by monitoring motor current. The power delivered to theinstrument may be controlled by varying motor voltage and/or current toachieve a constant motor speed with varying load.

Mounted in the staple holding portion of the instrument is a removablestaple cartridge 80. The cartridge holds four rows of staples 81. Therows are parallel and in adjacent rows the staples are off-set as iswell known in the art. The cartridge is placed so that it is oppositethe anvil portion of the instrument and snaps into the staple holdingportion of the instrument as shown. As depicted in the figures,extending the length of the staple portion of the instrument is thesmaller diameter portion of the threaded rod. Mounted on this rod, tomove along the rod as the rod rotates, is a knife member 82 and adriving wedge member 83 which are inner-connected. The wedge memberprecedes the knife member as they move along the threaded rod. As thewedge member moves down the threaded rod, it drives the staples out ofthe cartridge, via the individual staple drivers 84. The staples passthrough the tissue and against the anvil to form the staples in thetissue. The knife 82 following the driving wedge cuts the tissue betweenadjacent rows of staples. The driving wedge is actually two pieces; thatis, it has one wedge piece on one side of the knife to drive the stapleson that side of the knife and a like wedge piece on the opposite side ofthe knife to drive the staples on that side of the knife.

When the anvil portion 75 is closed as shown in FIG. 7, the closure nut77 moves a stop member 85 forward so that the firing nut 86 on which theknife 82 and wedges 83 are disposed is moved forward and engages thethreads of the smaller diameter portion 73 of the threaded rod to moveforward along the rod and drive the staples 81 and cut tissue. Thefiring nut 86 is biased, using a suitable means, so as not to engage thethreaded rod until a stop member 85 is activated. Once the firing nuthas moved to its most forward position to drive and form all of thestaples and cut the tissue, it engages a suitable contact 87 whichimmediately reverses the motor to retract the firing nut. In its fullyretracted position, the firing nut 86 moves the stop member 85rearwardly causing the closure nut 77 to then retract and open the anvilportion 75 of the head of the instrument. Another configuration would beto locate contacts in the handle portion of the instrument and use afollower nut on the rotating shaft to monitor position. It should bepointed out that it is desirable to locate as many as possible of thecontacts and sensors in the handle portion of the instrument so that thehead or business end can be maintained as small as possible and stillaccomplish the desired step in a procedure. By maintaining the head andshaft of the instrument as small as possible, the opening in the patientrequired for inserting the instrument may be kept small, thus increasingsome of the benefits of an endoscopic procedure. As can be appreciated,various information may be transmitted during the operation of theinstrument; for example, the movement of the stop member pushing thefiring nut to the threaded rod for movement can be sensed. The mostforward position of the wedges and knife may be sensed. The reversal ofthe motor may also be sensed as well as the movement of the stop memberto open the anvil portion etc. Furthermore, if desired the presence of acartridge and the presence of staples in that cartridge may also besensed. All of this information may be fed back to a controller andstored and manipulated in the control unit so that the surgeon using theinstrument will instantaneously receive information as to the placementof the staples, the cutting of the tissue, the presence of staples inthe cartridge, etc.

Referring to FIGS. 11 through 16, there is depicted an endoscopicligating system of the present invention. The ligator comprises a handleportion 80 having appropriate on-off 81 and power control 82 switches. Ahollow circular casing 83 extends from the handle portion and a clipapplying head portion 84 is disposed at the opposite end of the circularcasing. As more clearly shown in FIG. 12, in the handle portion is arotatable drive shaft 85. One end of the drive shaft at the rear of thehandle includes a connection 86 so that it can be connected to a DCmotor or other suitable power means. The opposite end of the drive shaftis threaded 87. The threaded portion of the drive shaft engages athreaded end 88 of a longitudinally moveable rod 89. The rod isconnected to longitudinally extending shaft 90. The shaft extendssubstantially the full length of the instrument from the handle to thehead or business end of the instrument. When the drive shaft 87 isrotated, the rod 89 and longitudinally extending shaft 90 move forwardand when the rotation of the drive shaft is reversed, the rod andlongitudinal extending shaft is retracted.

As shown in FIG. 13, the longitudinally extending shaft is mounted in asuitable support tube 115. The shaft comprises a longitudinally moveablecam channel 112, an enclosing member 113, a floor 110 opposite theenclosing member, a feed bar 99, an end cap 114, and a track 98 forholding ligating clips. Attached within the cam channel are the jaws 111of the instrument. In operation, when the cam channel is movedforwardly, it encloses the jaws and brings them together to close a clipwhich has been placed in the jaws. When the drive shaft 87 is reversed,the channel retracts and the jaws opens. Also included in the shaft area magazine or a stack of clips 97 held in track 98. The track also holdsa feeder spring 94, lock lever 95 and feed shoe 96. The clips arepositioned in the path of the feed bar 99 by spring 94. A lifter spring93 is held in place over clip track 98 by shroud 92 and acts to placethe first clip of the magazine into the plane of the feed bar forposition in the jaws. The operation of this portion of the instrumentcan best be seen in FIGS. 14, 15, and 16. As the cam channel 112 isurged forwardly, it engages the outer surface of the jaws 111 and pushesthem towards each other to close the clip 120 about tissue 121. When thecam channel retracts, the jaws open. The clip magazine 97 is advancedforwardly and another clip is placed within the jaws. This happens whenthe spring 94 is released and the feed shoe advances the next clip fromthe stack of clips, which has been positioned in the path of the feedshoe by the spring so that another clip may be placed. Suitable sensingmembers 123 and 124 in the jaws can determine whether or not there is anappropriate clip in the jaws, whether or not the clip is appropriatelyclosed and when the stack of clips is empty. All of this information maybe fed back to a controller for storage and manipulation and appropriateinformation reported to the operator of the instrument.

While I have described my new system with specific reference to a linearstapler-cutter instrument and a ligating clip applier, it of course, canbe used with other endoscopic instruments. For example, my new systemcould be used to control an electro-cauterizing instrument. My newsystem could be used to control the activation of such an instrument aswell as the irrigation and suction used with cauterizing instruments.

In all of the previous embodiments, the sensing mechanism has been usedto sense the operation of the instrument and to sense whether or notappropriate tissue is in the appropriate position, etc. It should beappreciated that the instruments may also be designed to sense physicalparameters of the surrounding environment. For example, they may sensethe blood oxygen content or tissue density of adjacent tissue or varioushemostasis characteristics of adjacent tissue and the like may be used.

In FIG. 17, there is depicted the head of an instrument which includes asensing member used to sense the blood oxygen content of adjacenttissue. In this embodiment, the instrument is a linear staplinginstrument though other instruments are also meant to be encompassed inthis embodiment. FIG. 17 depicts the head or business end 160 of such aninstrument. The head comprises a staple or staple cartridge holdingmember 161 and a pivotally mounted anvil member 162 similar to thatdepicted and described in conjunction with FIG. 6. A light emittingdiode (LED) 163 and phototransistor receiver 164 are disposed in thestaple holding member. The transistor receiver comprises one or morephoto-transistors and appropriate resistors. When tissue to bemanipulated is placed between the staple member and the anvil member anelectrical pulse is applied to the LED to cause light to be emitted bythe LED. The emitted light contacts the tissue and, depending on theproperties of the tissue, a portion of the light is reflected from thetissue to the photo-transistor thereby creating an electrical signal indirect proportion to the received optical signal. The amount of lightstriking the photo-transistor may be measured and correlated to adesired property of the tissue such as oxygen content. The indirectmeasurement of tissue penetration via an opto-electronic signalconversion is used to control desired operations of the instrument. Theoperations that might be controlled would be the opening and closing ofthe anvil member and/or the firing of the staples. This is accomplishedby feeding the light measurement to a controller which would in turncontrol the power source used to operate the instrument. Also, thisinformation could be supplied to the surgeon via a video display. Thesurgeon could use this information to determine proper positioning ofthe instrument or other procedure related manipulations.

FIG. 18 portrays in a simple block diagram one form of a systemaccording to the present invention. In this embodiment the endoscopicinstrument is a stapler and cutter 200. The status of the instrument andvarious messages are communicated to the user by an interface with anendoscopic video camera 201 and monitor system 202. The system alsoincludes an instrument microprocessor/controller 203. The endoscopicinstrument is powered by a DC motor 204 and is connected to thecontroller by a cable 205. The controller is micro-processor based andincludes circuits for sensing, motor control, sensor interface, videointerface and power supply. The instrument includes miniature sensors todetect the power and/or force being used and limit switches and contactsto turn the motor on and off at predetermined positions. Limit switchesare also used to detect various interlocks used in the instrument. Theinstrument may also include sensors to determine the position of theanvil to the cartridge and whether or not staples are present in thecartridge. All sensors, switches, and motors are connected to thecontroller via the interface cable 205. This information, fed into theappropriate controller, is stored and manipulated and fed to a centralprocessing communication system. Some information will be processeddirectly through the hard wired circuits. It is important to note thatit is desirable to incorporate critical instrument functions in to thehardwired logic of the controller whenever possible. The controller thenmay be used for non-critical functions and information processing. Theprocessed and manipulated information is fed to a video display screenand/or a suitable written or audio display mechanism. The informationmay also be fed back to the instrument controller to control some or allof the instrument functions.

In FIG. 19 there is depicted a configuration of hardware that could beused in the system of the present invention. From the sensor input fromthe specific endoscopic instrument used, the control logic can makedecisions and/or actions on things such as tissue compression, positionand proximity, electrical properties, chemical properties, temperatureetc.

The control logic may be based on analog computing, gate array logic,hard-wired combinational logic, or sequential embedded microprocessorcontrol, etc. or even some combination of electrical, mechanical,hydraulic or pneumatic logic.

FIG. 20 is a simplified flow diagram for the control logic set forthabove and described in conjunction with FIGS. 18 and 19.

It should now be evident that there has been described herein animproved endoscopic system that embodies a high degree of control andreliability while expanding the scope of the actions that can beaccomplished by any specific instrument to provide improved endoscopicprocedures.

Although the invention has been described by way of examples ofpreferred embodiments, it will be evident that other adaptations andmodifications may be employed without departing from the spirit andscope of the invention.

What is claimed is:
 1. A stapling instrument for use in an endoscopicprocedure comprising:a head portion, a handle portion and a connectingportion connecting said head portion to said handle portion; said headportion comprising means for holding a cartridge of staples, firingmeans for ejecting staples from said cartridge and anvil means to formsaid staples, said anvil means being disposed in relationship to saidcartridge holding means to allow tissue to be disposed between saidcartridge and said anvil means; a rotatable shaft disposed in saidconnecting portion; converting means disposed at one end of saidrotatable shaft and connecting said firing means to said shaft toconvert the motion of the shaft into a force to eject said staples fromthe cartridge and form said staples in the tissue, means disposed at theother end of said rotatable shaft for rotating said shaft, a firstsensing means disposed in said head portion for detecting a physicalproperty of the tissue placed between said cartridge and said anvilmeans, a second sensing means for detecting the force used to eject andform the staples; and control means interconnected to both said firstand second sensing means to control the ejection and formation of thestaples.
 2. A stapling instrument according to claim 1 wherein the anvilmeans is pivotally connected to the means for holding a cartridge ofstaples at one end thereof.
 3. A stapling instrument according to claim1 wherein the cartridge of staples contains at least 2 parallel rows ofstaples.
 4. A stapling instrument according to claim 3 wherein the headportion includes cutting means reciprocally movable between 2 rows ofstaples.
 5. A stapling instrument according to claim 1 which includes athird sensing means disposed in said instrument for measuring a physicalproperty of the instrument.
 6. A stapling instrument according to claim1 wherein the anvil means is pivotally connected to the means forholding a cartridge of staples at one end thereof, the cartridge ofstaples contains at lest two parallel rows of staples, the head portionincludes cutting means, said cutting means comprising a knife which ismovable between adjacent rows of staples and the converting means alsoconverts the motion of the shaft into a force to move said knife.
 7. Astapling instrument according to claim 6 which includes a third sensingmeans disposed in said instrument for determining the position of theknife.
 8. A stapling instrument according to claim 1 wherein the firingmeans is a D.C. motor.
 9. A stapling instrument according to claim 8wherein the D.C. motor is releasably attached to the instrument.